PAC Tour REGISTRATION FORM
Complete and Mail to PAC Tour, PO Box 303, Sharon, WI 53585 262-736-2453 or send back by email to
info@pactour.com
You can BOLD the TEXT to indicate your choice.
Be sure to enclose/attach a photocopy or scanned copy of your medical insurance card, both sides please!
Please fill in registration form and return (This will also be your Health Questionnaire)
First Name
Last Name
Address
City
Home Phone
State
Zip
Mobile Phone
Email
Occupation
Sex
Age
Birth Date
Eye Color
Height
Male
Female
Birthplace
Hair color
Weight
MEDICAL- List two people to contact in case of an emergency
Name
Phone
Relationship
Name
Phone
Relationship
Name of personal doctor
Phone
Name of Health Insurance
Policy #
List any physical disorders in case of an emergency:
Allergies to Food, Medicine or other items
Names of prescription medications currently taking
Date of most recent Tetanus shot (we recommend you are current)
Do you have any serious health problems cycling in the heat?
I am registering for:
You can BOLD the TEXT to indicate your choice.
2016 Desert Camp
Prices final as of 8/12/15
$500 non-refundable deposit required
Historic Hotels
Double Occupancy
Single Room Supplement $450
First Century
Double Occupancy
Single Room Supplement $400
Chiricahau
Double Occupancy
Single Room Supplement $450
Second Century
Double Occupancy
Single Room Supplement $400
Mountain Tour
Double Occupancy
Single Room Supplement $450
Register by December 1st to receive custom jersey. Final payment due January 15, 2016
Or Opt out of jersey and other commemoratives to save $100 -
OPT Out
__________________________________________________________________________________________
Western Route 66 April 2016 Price set as of 8/12/15 $500 non-refundable deposit required
Western Route 66
Double Occupancy
Single Room Supplement $1,200
Register by February 1, 2016 to receive custom jersey. Final payment due February 9, 2016
_____________________________________________________________________________________________
Northern Tour July 2016 Price set as of 8/12/15 $500 non-refundable deposit required
Northern
Double Occupancy
Single Room Supplement $2,100
Register by May 1, 2016 to receive custom jersey. Final payment due May 15, 2016
_____________________________________________________________________________________________
Eastern
September 2016
Eastern
Price set as of 8/12/15
Double Occupancy
$500 non-refundable deposit required
Single Room Supplement $TBD
Register by July 1, 2016 to receive custom jersey.
Final payment due July 15, 2016
_____________________________________________________________________________________________
PLEASE “Bold” Selection or type YES in front of your choice
Jersey
Men’s
OR
Extra Small
Women’s
Small
Medium
Jersey Sleeve Style:
Sleeveless
Jersey Zipper Style:
Full Zip
Large
Short Sleeve
¾ Zip
Please indicate Jersey Cut by bolding or circling the word - RACE CUT
Men’s OR
T-Shirt Size:
Extra Small
Small
Medium
Extra Large
or
Club Cut
Women’s:
Large
Extra Large
To register: Complete these forms and scan them to info@pactour.com or you can mail them with your deposit
check. We would prefer you send a check, if you can, to save PAC Tour the processing fees.
Please email info@pactour.com to alert Susan that you are registering by mail.
You need to print, sign and mail the Payment/Cancellation and Liability form and send them to the office. Make a
copy for your records, noting the dates for payments.
To pay by credit card, use the MAKE A PAYMENT link on the PAC Tour web site under the Register Tab or by
calling us with your credit card information. Susan’s cell: 612-804-9970
Payment Schedule/Cancellation Info:
Include deposit amount with this form to hold your reservation. Final payment amount is based on the number of registered riders, as
listed on the web site. Final payment dates are listed above for each tour.
Before you sign up we recommend you consider trip cancellation insurance to protect you in the event you are unable to attend or are
forced to leave the tour early. Call Travel Guard at 1-877-901-7599 and mention PAC Tour. This insurance policy could be your
refund if you need to cancel – provided you purchased the correct policy.

Riders canceling before January 1st of the year of their tour will receive a partial refund of their deposit.

Riders canceling after January 1st of the year of their tour will be charged their entire non-refundable deposit.

Final payments are due ~80 days before fly in of the tour or on January 15 th for all Desert Camp Weeks

A late fee of $150 will be assessed after 10 days (70 days out) – should a rider fail to make the final payment on time.

Fifty percent of the tour costs will be charged for cancellation within 21- 60 days of fly in.

No refunds for canceling within 20 days of fly in.

A fee could apply for switching tours. When possible, a portion of deposits may be applied as a credit toward future tours.
Tour prices are based on double occupancy hotels each night. You may pay an additional amount if a single room is desired or
required. PAC Tour cannot guarantee finding everyone a roommate. Should you be the final person to register for a tour and wish
double occupancy and a roommate is not available, you will be asked to pay the single supplement if you wish to register. If a
roommate becomes available, you will be refunded the unused portion of the single supplement. During a tour if your roommate goes
home, you will be paired with a new roommate. If you need to stay in a single room, you must pay the single supplement for the
remainder of the tour.
Riders are responsible for extra costs due to tour changes caused by acts of God or other emergencies.
A PAC Tour gear bag is supplied and must be used to standardize truck loading. PAC Tour gear bags are not supplied for Desert
Camp.
I understand the cancellation and refund policies of PAC Tour as stated above.
Sign here: ________________________________________ Date: _________________
My $500 deposit check is enclosed
I have paid my deposit using my credit card through the link on the PAC Tour web site.
I have called in my payment with credit card to Susan 612-804-9970
Please mail in this signed application with your deposit check to finalize the application process.
PAC Tour, PO Box 303, Sharon, WI 53585
262-736-2453
property damage, property theft or actions of any kind
which may hereafter accrue to me or my traveling to and
from this event, and the Following Entities or Persons;
PAC Tour, LLC
Lon Haldeman
Susan Notorangelo
and their directors, officers, employees, volunteers,
representatives and agents, the event holders, event
sponsors, event directors, event volunteers;
I acknowledge that this athletic event is an extreme test
of a person’s physical and mental limits and carries with
it the potential for death, serious injury and property
loss.
The risks include but are not limited to, those caused by
terrain, facilities, temperature, weather, conditions of
athletes, equipment, vehicular traffic, actions of other
people including, but not limited to, participants,
volunteers, spectators, coaches, event officials, and event
monitors, and or producers of the event, and lack of
hydration. These risks are not only inherent to athletics,
but are also present for volunteers.
I hereby assume all of the risks of participating and or
volunteering in this event. I realize that liability may
arise from negligence or carelessness on the part of the
person or entities being released, from dangerous or
defective equipment or property owned, maintained or
controlled by them or because of their possible liability
without fault.
(B) Indemnify and Hold Harmless the entities or persons
mentioned in this paragraph from any and all liabilities
or claims made by other individual or entries as a result
of any of my actions during this event.
I hereby consent to receive medical treatment which may
be deemed advisable in the event of injury, accident and
or illness during this event.
I understand that at this event or related activities, I may
be photographed. I agree to allow my photos, video or
film likeness to be used for any legitimate purpose by
the event holders, producers, sponsors, organizers and or
assigns.
This AWRL shall be construed broadly to provide a
release and waiver to the maximum extent permissible
under applicable law.
I hereby certify that I have read this document; and, I
understand it’s content.
Print Name __________________________
Signed ______________________________
I certify that I am physically fit, have sufficiently trained
for participation in the event and have not been advised
otherwise by a qualified medical person.
I acknowledge that this Accident Waiver and Release of
Liability (AWRL) form will be used by the event
holders, sponsors and organizers, in which I may
participate and that will govern my actions and
responsibilities at said events.
Age_________
Date _________
If participant under the age of 18, please have guardian
sign waiver.
Participant name ___________________________
Age _________
Signature of Guardian_______________________
In consideration of my application and permitting me to
participate in this event, I hereby take action for myself,
my executors, administrators, heirs, next of kin,
successors, and assigns as follows:
(A) Waive, Release and Discharge from any and all
liability for my death, disability, personal injury,
Relationship _____________________________
Date: __________